Flexible Mooring Concept
47 The Street - Easton Royal - Wiltshire - SN9 5LY
Tel: 01672 - 811318 Fax: 01672 -811231 e-mail: josher@globalnet.co.uk

Your details
Mr/Mrs/Ms/Miss:
Surname :
Initials:
Address:

County:
Post Code:
Daytime Phone No:
Evening Phone No:
Fax No:
e-mail address:

Your home mooring details
I have a Narrowboat / Cruiser whose length (including fenders) is:______ ft.

Which is moored on the Canal / River in Map area N1 / N2 / E1 / E2 / S1 / S2 / W1 / W2 which is a Marina / Towpath mooring. The nearest Town or City is:_________________

The maximum mooring length I have available for swapping is:____ feet.

Where you want to swap your mooring for (Circle one area only in each choice)
My first choice is: N1/N2/E1/E2/S1/S2/W1/W2 N/E/S/W
If unavailable my second choice is: N1/N2/E1/E2/S1/S2/W1/W2 N/E/S/W

The mooring to which you transfer may need to know these details
My Boat Licence is issued by:__________________________ Expiry Date:__________
I have a Boat Safety Certificate No:______________________Expiry Date:__________
My Insurance Certificate is issued by:____________________ Expiry Date:__________

Agreement and Payment Authorisation
I enclose a cheque / please debit my credit card for £39.95, being the fee for entry into the Mooring Exchange scheme. I understand that FMC only provides an introduction service and has no further liability or responsibility for the operation of the exchange once the details have been sent to me. I agree that the details may be held on a computer record by FMC.

I authorise FMC to deduct the sum of £9.95 for each introduction from my Credit Card, whose details follow.

Signature:____________________________
Date:______________

VISA / MASTERCARD Card number :______________________
Name as printed on card:____________________________Expiry Date:________
Note: These credit card details will be deleted from the computer once a successful match has been made and you have been informed.